Rheumatic disorders prepU
A nurse is preparing a client with systemic lupus erythematosus (SLE) for discharge. Which instruction should the nurse include in the teaching plan? "Exposure to sunlight will help control skin rashes." "There are no activity limitations between flare-ups." "Monitor your body temperature." "Corticosteroids may be stopped when symptoms are relieved."
Correct response: "Monitor your body temperature." Explanation: The nurse should instruct the client to monitor body temperature. Fever can signal an exacerbation and should be reported to the physician. Sunlight and other sources of ultraviolet light may precipitate severe skin reactions and exacerbate the disease. Fatigue can cause a flare-up of SLE. Clients should be encouraged to pace activities and plan rest periods. Corticosteroids must be gradually tapered because they can suppress the function of the adrenal gland. Abruptly stopping corticosteroids can cause adrenal insufficiency, a potentially life-threatening situation.
The nurse is teaching a newly diagnosed client about systemic lupus erythematosus(SLE). What statement by the client indicates the teaching was successful? "This disorder is more common in men in their thirties and forties than in women." "The belief is that it is an autoimmune disorder with an unknown trigger." "SLE has very specific manifestations that make diagnosis relatively easy." "The symptoms are primarily localized to the skin but may involve the joints."
Correct response: "The belief is that it is an autoimmune disorder with an unknown trigger." Explanation: Systemic lupus erythematosus is believed to be an autoimmune disorder but the triggering mechanism is not known. The disorder is more common in women than in men, most with the disorder in the 3rd or 4th decade of life. The disease is considered the "great imitator" because the clinical signs resemble many other conditions. SLE is a diffuse connective tissue disease that affects multiple body systems.
The nurse is teaching a client about rheumatic disease. What statement best helps to explain autoimmunity? "You have inherited your parent's immunity to the disease." "Your symptoms are a result of your body attacking itself." "You have antigens to the disease, but they do not prevent the disease." "You are not immune to the disease causing the symptoms."
Correct response: "Your symptoms are a result of your body attacking itself." Explanation: In autoimmunity, the body mistakes its own tissue for foreign tissue and begins to attack it. Symptoms develop as the body destroys tissue. The body is in effect attacking itself. The other statements do not explain autoimmunity.
A client is experiencing symptoms that are suspected to be related to systemic lupus erythematosus. What cutaneous symptom occurs in about 50% of clients affected by this disease? Diffuse purplish lesions on the trunk Butterfly-shaped rash on the face over the bridge of the nose and cheeks Fluid-filled vesicles clustered on the cheeks, chin, and forehead Pustules scattered on the chest and back
Correct response: Butterfly-shaped rash on the face over the bridge of the nose and cheeks Explanation: A prominent sign for about half of the clients with SLE is a red, butterfly-shaped rash known as malar rash, on the face over the bridge of the nose and the cheeks. The word lupus means "wolf." The term may have been used as a description for the facial rash that, to some, resembled the mask of reddish-brown fur on a wolf. The other choices are not routinely seen with SLE.
The nurse is reviewing the diagnostic test findings of a client with rheumatoid arthritis. What would the nurse expect to find? Increased red blood cell count Increased C4 complement Elevated erythrocyte sedimentation rate Increased albumin levels
Correct response: Elevated erythrocyte sedimentation rate Explanation: The erythrocyte sedimentation rate (ESR) may be elevated, particularly as the disease progresses. ESR shows inflammation associated with RA. Red blood cell count and C4 complement component are decreased. Serum protein electrophoresis may disclose increased levels of gamma and alpha globulin but decreased albumin.
A client is being discharged from the hospital after being diagnosed with and treated for systemic lupus erythematosus (SLE). What would the nurse not include when teaching the client and family information about managing the disease? If you have problems with a medication, you may stop it until your next physician visit. Avoid sunlight and ultraviolet radiation. Pace activities. Maintain a well-balanced diet and increase fluid intake to raise energy levels and promote tissue healing.
Correct response: If you have problems with a medication, you may stop it until your next physician visit. Explanation: Take medications exactly as directed and do not stop the medication if symptoms are relieved unless advised to do so by the physician. Sunlight tends to exacerbate the disease. Because fatigue is a major issue, allow for adequate rest, along with regular activity to promote mobility and prevent joint stiffness. Maintain a well-balanced diet and increase fluid intake to raise energy levels and promote tissue healing.
The nurse is teaching a client with osteoarthritis about the disease. What is the most important client focus for disease management? detection of systemic complications strategies for remaining active disease-modifying antirheumatic drug therapy prevention of joint deformity
Correct response: strategies for remaining active Explanation: The goals of osteoarthritis disease management are to decrease pain and stiffness and improve joint mobility. Strategies for remaining active are the most important client focus. The detection of complications, disease-modifying antirheumatic drugs management, and prevention of joint deformity are considerations, but not the most important priorities for the client.
A client is taking ibuprofen for the treatment of osteoarthritis. What education will the nurse give the client about the medication? Take the medication on an empty stomach in order to increase effectiveness. Since the medication is able to be obtained over the counter, it has few side effects. Take the medication with food to avoid stomach upset. Inform the health care provider if there is ringing in the ears.
Correct response: Take the medication with food to avoid stomach upset. Explanation: Ibuprofen is a nonsteroidal anti-inflammatory drug. The nurse should advise the patient to take NSAIDs with food to avoid stomach upset. Ibuprofen is available over the counter, but it still has side effects. Aspirin is known to cause ringing in the ears, not NSAIDs.
Which of the following disorders is characterized by an increased autoantibody production? Systemic lupus erythematosus (SLE) Scleroderma Rheumatoid arthritis (RA) Polymyalgia rheumatic
Correct response: Systemic lupus erythematosus (SLE) Explanation: SLE is an immunoregulatory disturbance that results in increased autoantibody production. Scleroderma occurs initially in the skin but also occurs in blood vessels, major organs, and body systems, potentially resulting in death. Rheumatoid arthritis results from an autoimmune response in the synovial tissue, with damage taking place in body joints. In polymyalgia rheumatic, immunoglobulin is deposited in the walls of inflamed temporal arteries.
The nurse is completing a health history with a client in a clinic. What assessment finding best correlates with a diagnosis of osteoarthritis? joint stiffness that decreases with activity erythema and edema over the affected joint anorexia and weight loss fever and malaise
Correct response: joint stiffness that decreases with activity Explanation: A characteristic feature of osteoarthritis (degenerative joint disease) is joint stiffness that decreases with activity and movement. Erythema and edema over the affected joint, anorexia, weight loss, and fever and malaise are associated with rheumatoid arthritis, a more severe and destructive form of arthritis.
The nurse is discussing the new medication that a client will be taking for treatment of rheumatoid arthritis. Which disease-modifying antirheumatic drug (DMARD) will the nurse educate the client about? Methotrexate (Rheumatrex) Etanercept (Enbrel) Methylprednisolone (Medrol) Infliximab (Remicade)
Correct response: Methotrexate (Rheumatrex) Explanation: Methotrexate is a DMARD that reduces the amount of joint damage and slows the damage to other tissues as well. Etanercept and Infliximab are TNF-alpha inhibitors that reduce pain and inflammation. Methylprednisolone is a steroid to reduce pain and inflammation and slow joint destruction.
